“Dear hospital CEOs, if you are going to the gemba (and you should), don’t do the corny undercover thing. Be real, be present. Help. Lead.”

The whole idea of the CBS-style “Undercover Boss” approach is deceitful and nowhere near as effective as real “gemba leadership,” as practiced by CEOs like Dr. Gary Kaplan at Virginia Mason Medical Center and Dr. Dean Gruner at ThedaCare. Kaplan and Gruner don’t need to go undercover, nor do I think they would want to!

When being interviewed, Musyj said he “learned about the pride that workers have in healthcare.” I hope that wasn’t really a new learning for him.

The anchor asked Musyj “what surprised you?” and he replied, “It’s interesting to see how the dots get connected together” and how “everyone relies on everyone else to get it done.” He added, “By taking a few hours to spend time in those areas, you see how the dots connect.” Musyj spent time in the kitchen, pharmacy, delivering supplies, nursing, etc.

Going to the gemba (a Japanese word the place where work actually gets done, such as the point of patient care) is a core part of the Lean management approach. Kaplan, it is said, goes to the gemba daily, and I know Gruner is out there quite often. See this video that shows Kaplan at the gemba. It’s a way of managing at ThedaCare, for leaders at all levels. Many of them, if not all, spend at least two hours in the gemba each morning, observing, coaching, and working with teams on improvement.

When I work with hospitals that are just starting with Lean, one of the things I have leaders and staff do is to spent days in the gemba observing in a structure way. They see what Musyj saw – that things usually get done through workarounds as people work through the waste and bad systems. People in healthcare are so dedicated, they’ll make things happen… but the waste often causes frustration, exhaustion, or errors to occur. You have to see the waste before you can fix it.

So why couldn’t Musyj go out there as the CEO? (EDIT: He says that he wasn’t hiding his identity). Why sneak around and hide from your staff? Why go undercover instead of being an adult and a professional and talking to people? They are scared of the CEO? They won’t talk to the boss? If so, that’s a problem in the culture that needs fixing and sneaking around only reinforces that the CEO is above everyone else.

I don’t know if you can really sneak around anyway. If people don’t even recognize the CEO, that’s a problem. Outsiders stand out. If the same team is always working in the pharmacy, some random guy who is there really sticks out. That’s often me, as an outside consultant. You’re not just randomly there for a day.

One person sort of called Musyj out (EDIT: Musyj says they were all joking):

“I went into a room one time, and somebody said to me, ‘You’re a dead ringer for the CEO of this place. Maybe you should ask him for some of his money,’ ” said Musyj, who played along. “I said, ‘Yeah, the CEO makes a lot of money, doesn’t he?’

I’m sure that person would feel like a fool if they now realize they were actually talking to the CEO. That’s where the dishonesty of Undercover CEO hurts, I think. And Musyj was pretending to be one of the guys by bitching about the CEO’s pay? Good grief.

Musyj seemed good natured about having been to the gemba, but I’m afraid he missed the real opportunity. Is that gemba time a one time exercise to get some publicity about, or is it a new way of managing?

The anchor asked what else surprised him and Musyj said, “Little things for staff. They just ask for little changes. If we can make the little changes for them, it makes such a big difference in their daily lives, so being able to hear that and to be able to make a change that, in the grand scheme isn’t that big, makes a big difference.”

For example:

Musyj says one small change he approved was taking wheels off a desk in the emergency department, because when patients would lean on the desk, it slid away. Musyj’s staff didn’t always recognize him as he walked among them.

Instead of just making that one change, I wish Musyj would stop and question why little things like that weren’t getting fixed on a regular basis. What can he do to change the culture, as CEO, to have Kaizen and improvement be a part of everybody’s daily work? Why does it take the CEO being there to get things fixed? Oh wait, the staff didn’t know it was the CEO. Or did they?

That example of fixing or removing the wheels on the cart is EXACTLY the type of small improvement that is managed through the daily Kaizen (or continuous improvement) process at healthcare organizations that are featured in our book like Franciscan St. Francis Health System (where my co-author works), Children’s Medical Center Dallas, Seattle Children’s Hospital, and others. That’s also the type of improvement that the users of our KaiNexus software are making, using our software to manage the Kaizen communication process at the front lines.

The TV reporter seemed to think it was sort of cute and admirable that Musyj went to the gemba (they weren’t calling it that, by the way). It’s good that he went, but I think the circumstances are questionable and the real lesson was lost to him, it seems.

17 Comments on "Why Does this Hospital CEO Have to Go Undercover? Or Does He?"

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Mark – thanks for your interest in WRH’s version of Undercover Boss. The process is NOT to sneak around. I have asked team members if they would invite me to “shadow” them. Over 40 to date have honoured me by saying yes. Results to date= beyond positive for everyone involved.

Mark our Hospital is a strong advocate of LEAN and one of the first Hospitals in the Province to adopt its teachings and learnings.

I did not commence this process in order to gain media attention. The media heard about it through the grapevine some 5 months after I started.

Most if not all of my 3000 plus team know who I am in or out of scrubs. I was recently in Cleveland and Detroit and was stopped by people who recognized me. Trust me Windsor is a small community.

When I walked into the room and a person made the comment about looking like the CEO it was a patient/family member that made that comment and I played along. It was stated to me in gest and I responded in gest. Has humour left the workplace ? “Good Grief” is right.

Also, maybe that says something about this whole process. Since I was wearing scrubs patients/families were NOT expecting to see the CEO. Therefore, instead of critizing this concept you should, of all people, be promoting it. More people should be doing this.

Leading is more than standing in front of a room and giving speeches. You have to walk and walk and talk the talk. This is just one part of it.

I appreciate your comments are meant to “sell” your services, software, books and processes. You have to make a living.

However, for a guy that has not worked in a healthcare setting you seem to claim to know a lot. A piece of advice to you…never stop learning and do not criticize something until you actually try it or throroughly investigate it. Maybe you need to get into some scrubs ? Opps forgot. You are a consultant.

If you took the time you would have gone to our wesbite and obtained my office, cell and home number in the welcoming letter that goes to each patient at WRH everyday and called me to investigate what I am actually doing before expressing an opinion based on facts from a media report.

The CEO missed a great opportunity to clarify to the anchor that unlike the TV show, he wasn’t sneaking around. It’s hard being on live TV, so I’ll cut him a bit of slack. But I understand the misunderstanding. Mark is trying to make a point to help others. I’m glad the CEO emphasizes those points about gemba management. Too bad it didn’t come out more clearly in the story.

I apologize if I drew any incorrect conclusions from the media report. It certainly seemed like this was an attempt at mimic-ing the “Undercover Boss” TV show and the impression was certainly given that people didn’t know it was you, as the CEO, in the workplace.

The “jest” was indeed lost in the news story. It sounded like an employee didn’t know it was you and that you were continuing a charade in your comments… you’d have to understand how it came across that way in the story and video. You said you went “undercover” and you didn’t really correct the anchor when she implied you were doing just like the CBS show.

I certainly do encourage more leaders to go to “the gemba” in an open, respectful, and transparent way. If that’s what you were doing, then bravo.

I spend quite a bit of time in hospitals and I do more than give speeches. So, I guess we have each been guilty of making assumptions. Good luck to you and your hospital.

“We talk about different changes and no one better than the frontline staff cause they’re the ones providing the service on a daily basis so they know how to improve things. So there’s no better way to improve things then to hear it from them,” says Musyj.

He says he plans to continue the initiative as long as there is staff willing to have him work beside them.”

But again, saying the exercise was “inspired” by Undercover Boss (where the entire gimmick is that the employees don’t know how the CEO is) certainly gives the wrong impression. Looking at the comments on the CBC page, readers/viewers there also got the wrong idea about “undercover.”

It seems the confusion is legitimate – I’d recommend the good CEO consider the primary source of the foul-up: The CBC.

All Canadians know (or at least should know) that the Official State Broadcaster is more than a little prone to errors of omission and leaving viewers, who have no other contexts to rely on, to come to their own conclusions on their reporting on many occasions. In some circles, the CBC is affectionately known as “Pravda” for these very reasons.

If anything, there is a lesson here about how CBC news reports are perceived beyond Canadian borders.

On the plus side, I’m actually impressed that a hospital in Canada is running Lean (we never hear of that in the local media), although to what degree and measure of success we don’t know (would be interesting to have objective results!) and that moreover, its CEO (or his staff) take the time to read a prominent blog on lean transformations such as Mark’s.

It’s unfortunate that said CEO didn’t take the high road in his rebuttal and had to make a personal swipe. Eye-for-eye, I suppose, however it reveals a careless ignorance of the author’s extensive experience in the field. I do hope he continues to read this blog and the forthcoming book to learn more before making similar reactions. If there is anywhere that can benefit from lean optimizations, it is Canadian health care.

After reviewing the video again, I have to recant some of my comments. The CEO should have corrected the host on the spot – it would have been the ideal moment to clarify that this is gemba management and not “Undercover Boss” – the two concepts are diametrically opposed.

I think it would behoove the CEO to undergo further media training to ensure that his message is clearly understood; definitely his media relations staff will need to pick up on this for future interviews.

My amateur media training would be to suggest a more mature response from the CEO would have been to say:

“Dear Mark, I can understand how you might think I was deceiving my staff like the CBS show, but I assure you that was not the case. Let’s talk so I can correct the record and I’d be happy to give you a chance to clear the air and revise your post. Sincerely…”

There are multiple hospitals that have embraced Lean, in part or in whole, in Canada. Well documented improvements in laboratory services and care of acute stroke patients have been achieved.

My own recent experience was highlighted in the national media for the significant reductions in length of stay within a portion of our Medicine program. Oddly enough, “Lean” was not mentioned once, but their was reference to using “new technology”. Frankly, the only new technology was listening to and empowering staff in a trusting and structured manner. We now are expanding the lean efforts to the rest of Medicine and numerous sites within our healthcare region are implementing changes brought about by Lean within the Emergency Department.

Never-the-less, there is a cultural shift that needs to occur throughout all the constituents of Canadian healthcare to make meaningful changes positive and sustainable. Our one-payer model of health service delivery often fosters cultures where the wheels on the cart issue do go unaddressed for far too long.

I wouldn’t blame the payer system for why small problems go unaddressed. It certainly happens here in the U.S.

Lean certainly is a growing trend across Canada, with many hospitals in Ontario and I’ve also visited hospitals in BC, Saskatchewan, Alberta, and Manitoba. Lots of changes in leadership styles and impressive results that come from the process improvement approaches and culture change.

I’m further impressed – and I’d be further impressed still if there were some profile given to the successes that have been achieved and where.

Certainly, as a consumer of health care services and someone who has relatives relying on them, the impression is that the “wheels-on-the-cart” type problems are extensive and the rule rather than the exception. I appreciate that the Queen Mary doesn’t turn on a dime, but it still feels like responsive healthcare delivery is a while off in the distance yet, until the culture shifts.

And I concur: The single-payor culture does contribute to some inefficient thinking that protects bad practices rather than promote effective alternatives.

Chris – I really think the root cause of things like that cart with wheels not getting fixed has more to do with management system and culture. We have similar problems in for-profit, not-for-profit, and government hospitals here in the U.S.

The same problems exist in other countries, regardless of the payer system.

A good benchmark (and it could be higher) is for healthcare employees to each generate 1 to 2 documented improvements per year. The number at Toyota is 10 per year and Toyota arguably has far less waste to begin with.

Mr. Musyj provided text of a memo that he sent to staff in advance of his gemba time. The memo had two pictures on top with the “Undercover Boss” show logo.

Reprinted with permission:

Undercover Boss is a television franchise series that has been released in multiple countries.

The show’s format is based on a senior executive of a company working undercover in their own firm to investigate how the company really works and identify how it can be improved, as well as rewarding the hard working staff.

I cannot actually work undercover but I thought it would be interesting to build upon the success of our Take a Walk In My Shoes and steal some ideas from Undercover Boss.

As a result I would ask any individuals, programs or services that would like for me to “work” with them for a few hours on a given day to contact me directly at [redacted] and I will arrange a date and time that is mutually agreeable to both of us.

He adds in his email to me: “”Take a Walk in My Shoes” is a program at WRH where people from the community are invited to “shadow” staff…. I am a very “hands-on” CEO that likes to roll his sleeves up. It has been a very beneficial process for all team members. The examples of change(s) that were made are simple ones that everyone can understand.”

The part of the story that really hit me was the thing about the wheels on the cart. No organization of any size can function well if a decision of this kind has to go all the way to the top.

Yet this sort of thing seems to be becoming more common, not less…Across organizations of all types, there is inadequate attention to proper organization-structure design and to the architecture of decision-making. In some cases, it seems that the combination of electronic communications with social-sciences jargon about “teams” has acted to undercut true decentralization.

David – I agree. I wish Mr. Musyj would have added some thoughts on the point about what he and other CEOs can do to create a Kaizen culture where problems like that are being addressed by front-line staff and their immediate supervisors, not just when the CEO is there.

Mark,
Since you already have a dialog started, I’d be interested in hearing a podcast of you and Dr. Musyj. I think many people in the media miss a lot of what Lean is all about. They paint a picture that is great for the masses, but really swings and misses for those with a bit of experience.
Jeff